Rising E-Cigarette Use Tied to More Smoking in Teens

Devices may serve as gateway to tobacco use, study author says

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THURSDAY, March 6, 2014 (HealthDay News) -- Teens who have tried electronic cigarettes may be more likely to smoke regular cigarettes, according to the authors of a new study.

"We found that e-cigarette use was actually associated with increased cigarette smoking among adolescents, contradicting the idea that e-cigarettes are effective smoking-cessation aids," study co-author Lauren Dutra said.

The researchers analyzed the smoking habits of about 38,000 middle school and high school students using data from the U.S. Centers for Disease Control and Prevention's National Youth Tobacco Survey. For years, the CDC has used the survey to glean information on teens' smoking and tobacco habits. In 2011 and 2012, they asked adolescents about their e-cigarette use too, Dutra said.

The researchers reported that between 2011 and 2012, the number of adolescents who had ever tried e-cigarettes doubled.

In 2011, 3.1 percent of adolescents who answered the survey had tried e-cigarettes at least once -- 1.7 percent of them in conjunction with regular cigarettes.

By 2012, the number of teens who said they'd tried e-cigarettes rose to 6.5 percent (2.6 percent used them along with cigarettes and 4.1 percent use e-cigarettes only), and 2 percent were current e-cigarette users. Among those who currently used e-cigarettes, about half used them along with regular cigarettes and half smoked only e-cigarettes.

"We are seeing the use of e-cigarettes among adolescents rapidly increasing, and it doesn't seem like they're using these products to successfully quit smoking," said Dutra, a postdoctoral fellow at the Center for Tobacco Research and Education at the University of California, San Francisco.

The study raises the question of whether e-cigarettes are a "gateway drug," and Dutra said she believes they are. "But that's more my opinion," she said. "The study doesn't show a causal relationship. I can't say e-cigarette use causes kids to smoke based on this finding. We need some more longitudinal data on this. But it does look like these devices are contributing to it."

Although they're often touted as a healthier alternative to smoking real cigarettes, Dutra said there's no research confirming e-cigarettes actually help people wean themselves off real cigarettes or curtail cigarette use. She is also concerned about the way electronic cigarette makers are marketing their products to young people.

"They come in flavors like bubblegum and advertisements that include images of bikinis," Dutra said. "In terms of basic numbers, e-cigarette use among adolescents is disconcerting. Most of these devices do have tobacco in them and we should be concerned and try to limit access to these products."

Michael Burke, the treatment program coordinator at the Mayo Clinic Nicotine Dependence Center, said the study shows that e-cigarettes seem to be making inroads with young people. He said it is concerning because most people who become addicted to nicotine start smoking when they're young.

"Ninety percent of people who catch this addictive disease, it happens before they're 18," Burke said. "Some e-cigarettes are being marketed without nicotine, so the immediate concern is with the ones with nicotine. They can start someone on a path of nicotine addiction and they'll eventually move to a better nicotine-delivery device and none is better or more damaging than cigarettes."

Burke said a lot of progress was made thanks to public health efforts and education between 1996 and 2004 in reducing youth smoking. "This has a chance of undermining the education and prevention activities that we're working on to reduce tobacco use," he said.

Study author Dutra said regulations need to be placed on the advertising and manufacturing of electronic cigarettes.

In an accompanying editorial in the March 6 issue of the journal JAMA Pediatrics, Frank Chaloupka, a professor of economics with the Institute for Health Research and Policy at the University of Illinois at Chicago, also said policies surrounding e-cigarettes need to be examined. More needs to be uncovered about the public health benefits or consequences of e-cigarette use, he said.

"Their exponential growth in recent years, including their rapid uptake among youths, makes it clear that policymakers need to act quickly," Chaloupka wrote.